Purpose: We compared the outcomes of cataract surgery in patients who underwent trabeculectomy and Ahmed glaucoma valve implantation. Methods: Twenty-nine trabeculectomized eyes of 29 patients (group 1) and 20 Ahmed glaucoma valve-implanted eyes of 20 patients (group 2) were enrolled consecutively. All subjects underwent thorough ophthalmic examinations, including slit-lamp microscopy and Goldmann applanation tonometry preoperatively, on postoperative days 1 and 7, and at postoperative months 1, 3, and 6. The surgical outcomes including intraocular pressure (IOP) and the required number of IOP-lowering medications were compared between the two groups. Results: The mean preoperative IOP in groups 1 and 2 was 15.34 ± 4.34 and 16.35 ± 3.44 mmHg, respectively (p = 0.265). In group 1, the IOP on postoperative day 1 increased significantly (by 3.86 ± 9.69 mmHg, p = 0.038), and the number of IOP-lowering medications rose at both 3 months (0.28 ± 0.70, p = 0.046) and 6 months (0.34 ± 0.94, p = 0.047) postoperatively. Group 2 exhibited no change in the IOP postoperatively or the number of IOP-lowering medications required in the postoperative period. Subconjunctival 5-fluorouracil injections for IOP control were required by two group 1 patients within 1 month postoperatively. Conclusions In patients with a trabeculectomized eye, the IOP increased immediately after cataract surgery; additional IOP-lowering procedures were required by some patients. The number of IOP-lowering medications increased after 3 months postoperatively. As cataract surgery may compromise filtering bleb function to a greater extent in trabeculectomized than in Ahmed glaucoma valve-implanted eyes, the former eyes require closer observation during the early postoperative period.

Purpose: We compared the outcomes of cataract surgery in patients who underwent trabeculectomy and Ahmed glaucoma valve implantation. Methods: Twenty-nine trabeculectomized eyes of 29 patients (group 1) and 20 Ahmed glaucoma valve-implanted eyes of 20 patients (group 2) were enrolled consecutively. All subjects underwent thorough ophthalmic examinations, including slit-lamp microscopy and Goldmann applanation tonometry preoperatively, on postoperative days 1 and 7, and at postoperative months 1, 3, and 6. The surgical outcomes including intraocular pressure (IOP) and the required number of IOP-lowering medications were compared between the two groups. Results: The mean preoperative IOP in groups 1 and 2 was 15.34 ± 4.34 and 16.35 ± 3.44 mmHg, respectively (p = 0.265). In group 1, the IOP on postoperative day 1 increased significantly (by 3.86 ± 9.69 mmHg, p = 0.038), and the number of IOP-lowering medications rose at both 3 months (0.28 ± 0.70, p = 0.046) and 6 months (0.34 ± 0.94, p = 0.047) postoperatively. Group 2 exhibited no change in the IOP postoperatively or the number of IOP-lowering medications required in the postoperative period. Subconjunctival 5-fluorouracil injections for IOP control were required by two group 1 patients within 1 month postoperatively. Conclusions In patients with a trabeculectomized eye, the IOP increased immediately after cataract surgery; additional IOP-lowering procedures were required by some patients. The number of IOP-lowering medications increased after 3 months postoperatively. As cataract surgery may compromise filtering bleb function to a greater extent in trabeculectomized than in Ahmed glaucoma valve-implanted eyes, the former eyes require closer observation during the early postoperative period.

PURPOSE: The aim of this study was to identify the prognostic factors and compare the long-term outcomes of staged hepatectomy and transarterial chemoembolization (TACE) for patients with spontaneous rupture of hepatocellular carcinoma (HCC). METHODS: This study is a multicenter, retrospective analysis of patients with newly diagnosed ruptured HCC. To compare overall survival between staged hepatectomy group and TACE alone group, we performed propensity score-matching to adjust for significant differences in patient characteristics. To identify prognostic factors, the clinical characteristics at the time of diagnosis of tumor rupture were investigated using Cox-regression analysis. RESULTS: From 2000 to 2014, 172 consecutive patients with newly diagnosed ruptured HCC were treated in 6 Korean centers. One hundred seventeen patients with Child-Pugh class A disease were identified; of which 112 were initially treated with transcatheter arterial embolization (TAE) for hemostasis and five underwent emergency surgery for bleeder ligation. Of the 112 patients treated with TAE, 44 underwent staged hepatectomy, 61 received TACE alone, and 7 received conservative treatment after TAE. Those that underwent staged hepatectomy had significantly higher overall survival than those that underwent TACE alone before matching (P < 0.001) and after propensity score-matching (P = 0.006). Multivariate analysis showed that type of treatment, presence of portal vein thrombosis, pretreatment transfusion >1,200 mL, and tumor size >5 cm were associated with poor overall survival. CONCLUSION: Staged hepatectomy may offer better long-term survival than TACE alone for spontaneous rupture of HCC. Staged hepatectomy should be considered in spontaneous rupture of HCC with resectable tumor and preserved liver function.
Carcinoma, Hepatocellular ; Chemoembolization, Therapeutic ; Diagnosis ; Emergencies ; Hemostasis ; Hepatectomy ; Humans ; Korea ; Ligation ; Liver ; Multivariate Analysis ; Retrospective Studies ; Rupture ; Rupture, Spontaneous ; Venous Thrombosis

OBJECTIVE: The link among carotid intima-media thickness (IMT), vascular elastic property and the disease activity of systemic lupus erythematosus (SLE) is not well defined. We investigated the association between carotid atherosclerosis, elastic properties of the carotid arterial wall and clinical parameters of SLE. METHODS: Fifty-one SLE patients and fifty healthy controls were included. Peak systolic global circumferential and posterior radial strains of carotid artery were measured to assess the elastic properties. Beta stiffness index was used as conventional method for the distensibility of the carotid artery. Information concerning SLE duration, cumulative dose of steroids and/or immunosuppressive drug intake was recorded, and SLE activity was assessed by SLE disease activity index (SLEDAI) score. RESULTS: Carotid plaques were more common in SLE patients. SLE patients with plaques were older and showed the increased mean IMT, high sensitivity C-reactive protein (hs CRP), IgG anti-cardiolipin antibody (aCL), and longer disease duration compared with those without plaques. Peak systolic global circumferential and posterior radial strain as well beta stiffness index were significantly lower in SLE group. Age, disease duration, hsCRP, IgG aCL showed significant correlations with mean IMT and parameters of carotid elastic property (all P's<0.05). CONCLUSIONS: Carotid atherosclerosis was more common in SLE patients, and carotid arterial stiffness had significant correlation with disease duration, hsCRP and IgG aCL level. Speckle tracking strain imaging is a comparative method for the assessment of elastic properties of carotid artery of SLE patients.
C-Reactive Protein ; Carotid Arteries* ; Carotid Artery Diseases* ; Carotid Intima-Media Thickness ; Humans ; Immunoglobulin G ; Lupus Erythematosus, Systemic* ; Steroids ; Ultrasonography ; Vascular Stiffness

Great advances have been made in the field of assisted reproductive technology (ART) since the first in vitro fertilization (IVF) baby was born in Korea in the year of 1985. However, it deserve to say that the invaluable data from fertility centers may serve as a useful source to find out which factors affect successful IVF outcome and to offer applicable information to infertile patients and fertility clinics. This article intended to report the status of ART in 2009 Korean Society of Obstetrics and Gynecology surveyed. The current survey was performed to assess the status and success rate of ART performed in Korea, between January 1 and December 31, 2009. Reporting forms had been sent out to IVF centers via e-mail, and collected by e-mail as well in 2012. With International Committee Monitoring Assisted Reproductive Technologies recommendation, intracytoplasmic sperm injection (ICSI) and non-ICSI cases have been categorized and also IVF-ET cases involving frozen embryo replacement have been surveyed separately. Seventy-four centers have reported the treatment cycles initiated in the year of 2009, and had performed a total of 27,947 cycles of ART treatments. Among a total of 27,947 treatment cycles, IVF and ICSI cases added up to 22,049 (78.9%), with 45.3% IVF without ICSI and 54.7% IVF with ICSI, respectively. Among the IVF and ICSI patients, patients confirmed to have achieved clinical pregnancy was 28.8% per cycle with oocyte retrieval, and 30.9% per cycle with embryo transfer. The most common number of embryos transferred in 2009 is three embryos (40.4%), followed by 2 embryos (28.4%) and a single embryo transferred (13.6%). Among IVF and ICSI cycles that resulted in multiple live births, twin pregnancy rate was 45.3% and triple pregnancy rate was 1.1%. A total of 191 cases of oocyte donation had been performed to result in 25.0% of live birth rate. Meanwhile, a total of 5,619 cases of frozen embryo replacement had been performed with 33.7% of clinical pregnancy rate per cycle with embryo transfer. When comparing with international registry data, clinical pregnancy rate per transfer from fresh IVF cycles including ICSI (34.1%,) was comparable to clinical pregnancy rate per transfer in European Society for Human Reproduction and Embryology report was 32.5% though lower than 45.0% for USA data. There was no remarkable difference in status of assisted reproductive technology in Korea between the current report and the data reported in 2008. The age of women trying to get pregnant was reconfirmed to be the most important factor that may have impact on success of ART treatment.
Electronic Mail ; Embryo Transfer ; Female ; Fertility ; Fertilization in Vitro ; Humans ; Korea* ; Live Birth ; Oocyte Donation ; Oocyte Retrieval ; Pregnancy ; Pregnancy Rate ; Pregnancy, Twin ; Reproduction ; Reproductive Techniques ; Reproductive Techniques, Assisted* ; Sperm Injections, Intracytoplasmic

The long QT syndrome (LQTS) is a rare hereditary disorder in which affected individuals have a possibility of ventricular tachyarrhythmia and sudden cardiac death. We investigated 62 LQTS (QTc > or = 0.47 sec) and 19 family members whose genetic study revealed mutation of LQT gene. In the proband group, the modes of presentation were ECG abnormality (38.7%), aborted cardiac arrest (24.2%), and syncope or seizure (19.4%). Median age of initial symptom development was 10.5 yr. Genetic studies were performed in 61; and mutations were found in 40 cases (KCNQ1 in 19, KCNH2 in 10, SCN5A in 7, KCNJ2 in 3, and CACNA1C in 1). In the family group, the penetrance of LQT gene mutation was 57.9%. QTc was longer as patients had the history of syncope (P = 0.001), ventricular tachycardia (P = 0.017) and aborted arrest (P = 0.010). QTc longer than 0.508 sec could be a cut-off value for major cardiac events (sensitivity 0.806, specificity 0.600). Beta-blocker was frequently applied for treatment and had significant effects on reducing QTc (P = 0.007). Implantable cardioverter defibrillators were applied in 6 patients. Congenital LQTS is a potentially lethal disease. It shows various genetic mutations with low penetrance in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group/genetics ; Calcium Channels/genetics ; Child ; Child, Preschool ; Electrocardiography ; Heart Arrest/genetics/pathology ; Humans ; Infant ; KCNQ1 Potassium Channel/genetics ; KCNQ2 Potassium Channel/genetics ; Long QT Syndrome/*diagnosis/*genetics ; Middle Aged ; Mutation/*genetics ; NAV1.5 Voltage-Gated Sodium Channel/genetics ; Penetrance ; Potassium Channels, Inwardly Rectifying/genetics ; Republic of Korea ; Risk Factors ; Seizures/genetics/pathology ; Young Adult

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder in patients with chronic kidney disease (CKD). However, little is known about the prevalence of GERD in dialysis patients. The aim of the present study was to investigate the difference in the prevalence of GERD in peritoneal dialysis and hemodialysis patients. METHODS: From July 2010 to August 2011, peritoneal dialysis patients (n=30) and hemodialysis patients (n=38) were enrolled. The prevalences of GERD were assessed at a single center with endoscopic findings and interviews using a questionnaire. Also, risk factors of GERD were evaluated. RESULTS: The prevalences of GERD in peritoneal dialysis and hemodialysis patients were 33.3% and 39.5% (p=0.748), respectively. The prevalences of erosive reflux esophagitis (ERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 23.7% (p=0.477), respectively. The prevalences of nonerosive reflux disease (NERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 13.2% (p=0.685), respectively. The prevalences of GERD, ERD and NERD were higher than those of the general population. The risk factor for GERD was age in hemodialysis patients. CONCLUSIONS: The prevalence of GERD in dialysis patients was higher than that in the general population. However, there was no significant difference between peritoneal dialysis and hemodialysis patients.
Aged ; Body Mass Index ; Diabetes Mellitus, Type 2/complications ; Esophagitis, Peptic/complications/epidemiology ; Female ; Gastroesophageal Reflux/complications/*epidemiology ; Gastroscopy ; Helicobacter Infections/complications ; Humans ; Kidney Failure, Chronic/*complications ; Male ; Middle Aged ; Peritoneal Dialysis/statistics & numerical data ; Prevalence ; Questionnaires ; Renal Dialysis/statistics & numerical data ; Risk Factors ; Smoking

PURPOSE: Drowning is a common preventable cause of accidental death. Although many studies about drowning injuries have been conducted, most are related to freshwater drowning. The aim of this study was to analyze the clinical features and prognostic factors in seawater drowning patients. METHODS: This study was performed retrospectively with sea water drowning patients who visited the emergency department at Pusan National University Hospital between January 2005 and December 2009. RESULTS: In total, 51 sea water drowning patients presented at the emergency department with a mean age of 48.65+/-15.40 years. The survival group included 42(82.4%) patients, and the death group was comprised of nine patients(17.6%). Fifteen patients arrested in the field, and cardiopulmonary resuscitation (CPR) was performed. Median immersion time in the death group was 15.0 minutes (range, 9.5~22.5 minutes). Among the death group, five patients had respiratory acidosis and nine showed pulmonary edema on a chest X-ray. Initial sodium level in the survival group was 146.30 mEq/L (range, 142.38~152.60 mEq/L), but the level was normalized with isotonic saline. CONCLUSION: Most drowning injuries occurred at night and in relatively young aged patients. CPR in the field did not result in good outcomes because of the longer immersion time. The death group had respiratory acidosis. Because the survival group did not show significant hypernatremia, isotonic saline as an initial fluid was thought to be appropriate. Drowning injuries occur differently based on geographic and social characteristics; therefore, local characteristics should be considered to establish preventive measures.
Acidosis, Respiratory ; Aged ; Cardiopulmonary Resuscitation ; Drowning ; Emergencies ; Fresh Water ; Humans ; Hypernatremia ; Immersion ; Prognosis ; Pulmonary Edema ; Retrospective Studies ; Seawater ; Sodium ; Thorax

Since the first descriptions of Brugada as a new clinical entity defined by sudden cardiac death in patients with typical electrocardiogram (ECG) patterns, Brugada syndrome (BS) has been increasingly diagnosed. This syndrome is known as a disease that is inherited via an autosomal dominant trait, and the SCN5A mutation has been found in 20-25% of BS patients. Because BS primarily manifests in adulthood, little information is available on BS during childhood. Although there have been several reports on adult BS in Korea, pediatric BS has not been reported. Herein, we report on childhood BS in two families. One infantile BS patient and his family had a novel SCN5A mutation (c.4035G>T, p.W1345C, heterozygote) in domain III of the sodium channel.
Adult ; Brugada Syndrome ; Death, Sudden, Cardiac ; Electrocardiography ; Humans ; Korea ; Sodium Channels ; Tachycardia, Ventricular

PURPOSE: To evaluate retinal damage following internal limiting membrane (ILM) peeling in macular hole and diabetic macular edema (DME) surgeries. METHODS: Forty-five eyes with macular holes and thirty-five eyes with DME underwent pars plana vitrectomy with ILM peeling. The structures of the ILM were investigated using transmission electron microscopy, and the grades of retinal tissue damage were analyzed. We additionally observed the clinicopathologic association of retinal damage with the development of retinal hemorrhage during ILM peeling and that seen with indocyanine green (ICG) staining. RESULTS: In all specimens, cellular fragments were observed on the retinal side of the ILM in both macular hole and DME patients. The thickness of the ILM in DME significantly increased (3.13+/-1.12 micrometer compared with that in patients with macular holes (2.41+/-0.77 micrometer, p=0.002). The frequency of minute retinal bleeding during ILM peeling was higher in macular hole patients (46.7%) than in those with diabetic macular edema (22.9%m p=0.028). Twenty-two eyes of 45 macular hole patients (48.9%) and 16 eyes of 35 DME patients (45.7%) had relative retinal damage. Overall, ILM performed in eyes which had minute bleeding during the peeling had more retinal damage (62.1%) than did those without hemorrhage (39.2%, p=0.049). ICG staining did not appear to influence retinal damage (p=0.81). CONCLUSIONS: ILM peeling can cause minor, but demonstrable, damage of the adjacent retina.
Eye ; Hemorrhage ; Humans ; Indocyanine Green ; Macular Edema ; Membranes ; Microscopy, Electron, Transmission ; Retina ; Retinal Hemorrhage ; Retinal Perforations ; Retinaldehyde ; Vitrectomy